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Professional - Non-Clinical
Manager, Program Support and Reporting - Pharmacy
Houston, TX, US
We are searching for a Manager of Program Support and Reporting – someone who works well in a fast-paced setting. In this position, you will be responsible for assisting with the interpretation of federal, state, and other regulations and requirements related to Medicaid and Children's Health Insurance Program (CHIP) and coordinating/providing the necessary reporting requirements in a timely manner. Develops, tracks, and reports performance/productivity metrics, and assures direct reports
are meeting established metrics. Frequently review processes, workflows, and policies/procedures to ensure they are accurate, current, and meet all regulatory requirements. Works collaboratively with leadership and others from various areas across the health plan to evaluate and implement new ideas and strategies that impact member care coordination and quality of life, while ensuring compliance with the above regulations and requirements. Continue development of key strategic initiatives and reporting by partnering with the finance and operating teams to translate strategic analysis into operational
decision-making.
Think you’ve got what it takes?
Job Duties & Responsibilities
• Develops strategies, policies, and procedures to ensure regulatory compliance.
• Reviews, interprets, and provides direction on new and changes to existing federal and state regulations and requirements mandated by Health and Human Services Commission (HHSC), Texas Medicaid & Healthcare Partnership (TMHP), Texas Department of Insurance (TDI), and other governing bodies. Remains current on Texas Medicaid Provider Procedures Manual (TMPPM), Uniform Managed Care Contract (UMCC), Uniform Managed Care Manual (UMCM), and other bodies of knowledge that impact Medicaid and CHIP requirements and have a direct impact on medical policy decisions and potential system configuration changes.
• Ensures that policies/procedures, standard operating procedures, desk-level procedures, and/or guidelines adhere to all Medicaid and CHIP regulatory requirements as they relate to benefits and reimbursement, and staff are adequately trained on them.
• Partners closely with the Program Support Unit (PSU) within the Health and Human Services Commission (HHSC) to understand and implement program and/or reporting changes.
• Develops methodology for analyzing and monitoring departmental operations, internal and State issued Corrective Actions Plans and Liquidated Damages.
• Ensure appropriate communications and partners with others both within and across teams to accomplish goals.
• Provides data and reporting on productivity and other metrics.
• Develops and implements process improvement initiatives.
Skills & Requirements
• Bachelor's Degree required
• Master's Degree business administration or related field preferred
• 4 years business operations in a healthcare of insurance environment required
• Management/leadership experience preferred
• 3 years' experience within TCHP preferred
About Texas Children’s
Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.
To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.
Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
